Air, water pollution and other environmental threats contribute to an equivalent of 1 in 6 deaths

College Park, MD—Pollution is linked to an estimated nine million deaths each year worldwide – equivalent to one in six (16%) of all deaths—according to a major new report in The Lancet. The report finds that exposure to pollution—including outdoor and indoor air pollution, water and soil contamination, and chemical pollutants—is one of the largest risk factors for premature death. Distinguished University Professor Maureen Cropper, chair of the Department of Economics, served as a commissioner and a coauthor of the report.

Most of these deaths are due to non-communicable diseases caused by pollution such as heart disease, stroke, lung cancer and chronic obstructive pulmonary disease (COPD).

With almost all of pollution-related deaths (92%) occurring in low- and middle-income countries, the researchers found that pollution disproportionately affects the poor and marginalized in every country worldwide. The authors of the report aim to focus attention on the issue across the political spectrum, and mobilize the will, resources, and the leadership needed to confront it.

“Pollution in its several forms is a huge public health issue,” Cropper said. “We must look for national and global policy pathways to help protect people at all income levels from exposure to environmental hazards.”

Global health burden of pollution

The study found that the largest contributor to pollution-related deaths is air pollution (including ambient air pollution which is outdoor air pollution comprised of gases and particulate matter; and household air pollution that results from the burning of wood, charcoal, coal, dung, or crop wastes indoors; and ambient ozone), linked to an estimated 6.5 million deaths in 2015 as a result of diseases such as heart disease, stroke, lung cancer, and COPD.

The next-largest risk factor was water pollution such as unsafe sanitation and polluted water sources, which are linked to 1.8 million deaths as a result of gastrointestinal diseases and parasitic infections.

Workplace pollution including exposure to toxins and carcinogens was linked to 0.8 million deaths from diseases such as such pneumoconiosis in coal workers, bladder cancer in dye workers, and asbestosis, lung cancer, mesothelioma, and other cancers in workers exposed to asbestos.

Finally, lead pollution was linked to 0.5 million deaths that resulted from high blood pressure, renal failure, and cardiovascular disease caused by lead in adults. Additional health effects caused by other forms of soil pollution (such as other heavy metals or chemicals) are not adequately researched, and so are not included in the study.

With many more chemical pollutants still to be identified and studied, the authors note that their figures are likely to underestimate the full health effects of pollution.

While almost all (92%) pollution-related deaths occur in low- and middle-income countries, the greatest impacts occur in countries that are currently undergoing rapid development and industrialization – with pollution responsible for up to one in four deaths in the most severely affected countries (such as in India, Pakistan, China, Bangladesh, Madagascar and Kenya.

In 2015, the greatest numbers of deaths due to pollution occurred in India (2.5 million deaths) and China (1.8 million).

As countries develop and industrialize, the type of pollution and the related health problems they face change. For example, water pollution and household air pollution are more common in early stages of industrial development, causing higher rates of pneumonia and diarrheal diseases in low- and middle-income countries. Deaths associated with water and household air pollution have reduced from 5.9 million deaths in 1990 to 4.2 million in 2015.

However, types of pollution associated with industrial development, such as ambient air pollution (including ozone), chemical, occupational pollution and soil pollution, have increased from 4.3 million (9.2%) in 1990 to 5.5 million (10.2%) in 2015 as countries reach higher levels of development.

Despite this, the authors argue that pollution is not the inevitable consequence of economic development, and applying similar legislation and regulation from high-income countries to low- and middle-income countries could help to improve and protect health as countries develop.

Economic costs of pollution

The costs of pollution-related death and disease are also highly concentrated in developing regions – especially when expressed as a percent of GDP. The value of lost output when a person dies prematurely is between 1.3% and 1.9% of GDP in low-income countries, compared to about 0.05% of GDP in high-income countries, and 0.13-0.16% of GDP globally. Healthcare spending on pollution-related diseases also disproportionately affects lower income countries. In Sri Lanka we estimate that air pollution-related disease alone accounts for an estimated 7% of health spending, whereas it is only 1.7% in high-income countries.

What people would pay to reduce their risk of death from pollution in 2015 amounts to US$4.6 trillion (equivalent to 6.2% of global economic output). Proportionately, this amount is higher as a percent of gross national income in low-income countries (8.3%) than in high-income countries (4.5%) due to higher pollution-related mortality in low-income countries. As the report does not include costs related to the environmental damage inflicted by pollution, the authors note that these are not the full costs of pollution.

About the Commission

The Lancet Commission on Pollution and Health is a two-year project that has involved more than 40 international health and environmental authors. Using data from the Global Burden of Disease study, it brings together comprehensive estimates on the effects of pollution on health, provides economic costs, and reveals the extent of contaminated sites across the world for the first time.

“Improving environmental health should be a public health priority,” Dr. Cropper said. “The work of the Commission will help achieve this goal. It will bring renewed attention to the impact of environmental risk factors on health and focus attention on contaminated sites–a risk factor not addressed by the Global Burden of Disease.”

The Commission was funded by European Union, UN Industrial Development Organization, the Swedish Ministry of Environment and Energy, the German Federal Ministry for the Environment, Nature Conservation, Building and Nuclear Safety, Royal Norwegian Ministry of Health and Care Services, the US Agency for International Development, the US National Institute of Environmental Health Sciences, the Icahn School of Medicine at Mount Sinai, and Pure Earth.